Re: Belgium: Mandatory Referral for Euthanasia

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Notes

1.The Belgian Act on Euthanasia of 28 May, 2002, Section 3§1. Unofficial translation by Dale Kidd under the supervision of Prof. Herman Nys, Centre for Biomedical Ethics and Law, Catholic University of Leuven, Belgium. Ethical Perspectives 9 (2002) 2-3, p. 182. (Accessed 2005-10-27)

2. House of Lords Select Committee on Assisted Dying for the Terminally Ill Bill. Minutes of Evidence; Examination of Witnesses. 13 January, 2005 (Questions 1880 - 1899): Professor Bart van den Eynden (Q1881) (Accessed 2005-10-25) Professor Bart van den Eynden is a Professor in Palliative Care at Antwerp University and a palliative care physician responsible for a 12 bed palliative care unit and of the palliative support team covering 1,000 acute hospital beds in Antwerp. He is an alternate on Belgium's 16 member Federal Inspection and Evaluation Committee on Euthanasia.

3. ". . . the whole movement for legislation of euthanasia in Belgium did not arise from a real caring for the suffering patient but started as a political concern and turned into an ideological debate with two opposite camps." House of Lords Select Committee on Assisted Dying for the Terminally Ill Bill. Minutes of Evidence; Examination of Witnesses. 13 January, 2005 (Questions 1855 - 1859): Professor Bart van den Eynden(Q1855) (Accessed 2005-10-25)
See also Broeckaert, B. Janssens, R. "Palliative Care and Euthanasia: Belgian and Dutch Perspectives."p.20-21 Ethical Perspectives 9/2-3 (June - September - 2002) 156 - 176 (Accessed 2005-10-27)

4."GPs 'must change attitude' over euthanasia." Expatica, 5 December, 2003 (Accessed 2005-10-13)

5. Letter from the Administrator, Protection of Conscience Project, to the Belgian Association of General Practitioners, 23 July, 2004.

6. Letter from the Belgian Association of General Practitioners to the Administrator, Protection of Conscience Project, 24 August, 2004.

7. Letter from the Administrator, Protection of Conscience Project to the Belgian Association of General Practitioners, 6 October, 2004. Letter from the Administrator, Protection of Conscience Project to the Belgian Association of General Practitioners,25 April, 2005 . Sent again by e-mail on 29 September, 2005.

8. "Euthanasia for 200 in first year."Expatica, 25 November, 2003. (Accessed 2005-10-13)

9. "One Belgian dies each day from euthanasia procedures."Expatica, 21 April, 2005. (Accessed 2005-10-13)

10. "One Belgian dies each day from euthanasia procedures."Expatica, 21 April, 2005. (Accessed 2005-10-13)

11. MOENS, M. Maintenance and Improvement of quality health care: The Belgian Health Care System Revisited September 27, 2003 (Accessed 2005-10-13)

12. In Table 5, MOENS, M. Maintenance and Improvement of quality health care: The Belgian Health Care System Revisited September 27, 2003 (Accessed 2005-10-13)

13. "Belgian euthanasia cases 'exceed official reports.'"Expatica, 6 September, 2005. (Accessed 2005-10-13)

14. "There are assumptions that it is the same quantity as it is in The Netherlands. It means that at least 50 per cent is not reported and maybe it is more, but because it is not reported you do not know." House of Lords Select Committee on Assisted Dying for the Terminally Ill Bill. Minutes of Evidence; Examination of Witnesses. 13 January, 2005 (Questions 1860 - 1879): Professor Bart van den Eynden(Q1866) (Accessed 2005-10-25)
Federal Control and Evaluation Commission chief Wim Distelmans suggested that, based upon Dutch experience, the actual number of Belgian euthanasia cases each month is 150, five times the reported number. Quoted in "Belgian euthanasia cases 'exceed official reports.'"Expatica, 6 September, 2005. (Accessed 2005-10-13)

15. "For some people, you get to a certain stage when you really can say, 'I've had enough of this palliative care. I'd like to kind of, kind of leave this word a bit more more quickly.' And I think, therefore, that physician assisted suicide should be an option within good palliative care services." Interview of Michael Irwin, 19 October, 2005. Outlook: BBC World Service (Accessed 2005-10-20)

16. Federatie Palliatieve Zorg Vlaanderen, Omgaan met euthanasie en andere vormen van medisch begeleid sterven (september, 2003) [Flemish Palliative Care Federation, Dealing with Euthanasia and Other Forms of Medically Assisted Death (September, 2003)] (Accessed 2005-10-27) In Dutch and English.

17. Broeckaert, B. Janssens, R. "Palliative Care and Euthanasia: Belgian and Dutch Perspectives."p.20-21 Ethical Perspectives 9/2-3 (June - September - 2002) 156 - 176 (Accessed 2005-10-27)

18. Broeckaert, B. Janssens, R. "Palliative Care and Euthanasia: Belgian and Dutch Perspectives."p.20-21 Ethical Perspectives 9/2-3 (June - September - 2002) 156 - 176 (Accessed 2005-10-27)

19. http://www.leif.be . "Het LEIFproject is een open initiatief en bestaat uit mensen en verenigingen die streven naar een menswaardig levenseinde voor iedereen, waarbij respect voor de wil van de patiënt voorop staat." (The Life'sEnd Information Forum project is an initiative of people and associations that strives to achieve a humane end of life for everyone by putting first respect for the will of the patient.)

20. House of Lords Select Committee on Assisted Dying for the Terminally Ill Bill. Minutes of Evidence; Examination of Witnesses. 13 January, 2005 (Questions 1860 - 1879): Professor Bart van den Eynden (Q1862) (Accessed 2005-10-25)

21. Here, again, the statement differs from the earlier position of the Federation, as described by Broeckaert and Janssens. The FPVZ had successfully argued that the role of the second physician in the euthanasia process be expanded from simply confirming the incurability of the patient's illness to confirming that the patient's mental or physical suffering cannot be alleviated, but had not suggested that a member of the palliative team would act as the second physician processing a euthanasia request.

22. The Federation argues that direct participation would completely contradict "the emphasis we wish to place on the continuity of the healthcare and emancipatory concern incorporated into the organisation of Flemish palliative care: the basic principle that organised palliative care exists to inform and to support and not to act in the place of normal healthcare." The "emancipatory concern" appears to be the desire to avoid "pseudo-choices" for euthanasia - decisions that are not actually freely made because the patient has been given no clear palliative alternative and is thus constrained in his choices. If so, it is not clear how this relates to what follows.

23. Rien Janssens, Hen ten Have, David Clark, Bert Brooeckaert et al., "Palliative Care in Europe. Towards a more comprehensive understanding." European Journal of Palliative Care 8 (2001): p. 20-23. Cited in Broeckaert, B. Janssens, R. "Palliative Care and Euthanasia: Belgian and Dutch Perspectives."p.20-21 Ethical Perspectives 9/2-3 (June - September - 2002) 156 - 176 (Accessed 2005-10-27)

24. World Health Organization Definition of Palliative Care. (Accessed 2005-10-13)

25. Doyle D, Hanks G, MacDonald N. Oxford Textbook of Palliative Medicine. Oxford University Press, 1993. Quoted at [site] (Accessed 2005-10-13)

26. American Academy of Hospice and Palliative Medicine Position Statements: Comprehensive End-of-Life Care and Physician-Assisted Suicide. Approved by the Board of Directors, June 25, 1997. (Accessed 2005-10-13)

27. Somerville, Margaret, Death Talk: The Case against Euthanasia and Physician Assisted Suicide. Montreal: McGill-Queen's University Press, 2001, p. 124, quoting T. Quill,"The Case for Euthanasia," "Searching for the 'Soul' of Euthanasia," 11th International Congress on Care of the Terminally Ill, Montreal, 1996.

28. Organ Trade GP suspended. BBC News,15 October, 2002 (Accessed 2004-01-06) See also Dyer, Owen, "Organ trafficking prompts UK review of payments for donors". British Medical Journal 2002;325:924 (26 October)

29. Wet betreffende de rechten van de patiënt, Art.8.§ 2 [Law Regarding the Rights of the Patient, Art. 8.§ 2 ] Selected sections in English and Dutch

30. Murphy, Sean, Planned Parenthood and "Anti-Choice" Rhetoric: A response to "Planned Parenthood Targets 'Anti-choice' Docs" [Mario Toneguzzi, Calgary Herald, August 19, 2004]

31. Budziszewski, Jay, "Handling Issues of Conscience".The Newman Rambler (Spring/Summer 1999, Vol. 3, No. 2).

32. House of Lords Select Committee on Assisted Dying for the Terminally Ill Bill. Minutes of Evidence; Examination of Witnesses. 13 January, 2005 (Questions 1860 - 1879): Professor Bart van den Eynden (Q1861) (Accessed 2005-10-25)

33. Document quoted in Project Report 2004-01 (Restricted circulation)

34. Benson, Iain, T. "Autonomy", "Justice" and the Legal Requirement to Accommodate the Conscience and Religious Beliefs of Professionals in Health Care (Revised March 2001)

35. "Shared decision making in the medical encounter: what does it mean? (or, it takes at least two to tango)." Social Science and Medicine 44, 681-692. In a later paper on the same subject, the authors stated: "If a physician cannot, in good conscience, endorse the patient's preference, then there is no agreement on the decision to implement even though the deliberation process was shared . . . patients face constraints in that their preferences . . . can only be implemented if a physician agrees to do so. On the other hand . . . A patient turned down by one physician can make the same treatment request to another . . . A refusal from the first physician does not preclude her from receiving the desired services from the second." Charles, C., Gafni, A., Whelan, T., 1999. "Shared decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model." Social Science and Medicine 49, 651-661